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General NPI Number Information
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NPI Number | 1023479839
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Entity Type | Individual
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Provider Name | KEVIN SULLIVAN MOTR-L
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Gender | Male
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Dates
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Enumeration Date | 03/08/2016
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Last Update Date | 03/11/2022
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Provider Practice Location Address
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Address Line | 8325 UNIVERSITY PKWY
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City | PENSACOLA
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State | FL
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Zip | 32514-4949
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Country | US
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Telephone | 850-898-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 10307 NIGHTWIND CIR
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City | CANTONMENT
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State | FL
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Zip | 32533-6651
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Country | US
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Telephone | 505-710-2587
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 3498
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 19447
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License Number State | FL
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